How have hospitals and large employers responded to the newly competitive health care environment in Massachusetts created by the enactment of Chapter 495 of the Acts of 1991 -- An Act Improving Health Care Access and Financing? Under this phase one project, the researchers analyzed hospital financial performance and insurance premium performance for Worcester County, one of the most competitive areas of the state in terms of the number of hospitals and beds relative to the population. The objective of this project was to identify whether there were changes as a result of increased competition in Worcester County, indicating that a statewide analysis is warranted. In addition, information obtained through these analyses should assist policymakers as they continue to debate, both at the state and national level, whether free market competition is more or less effective than government regulation in controlling health care costs.